Mona Hanna-Attisha, MD: Flint's Voice of the Voiceless

Background in pediatrics and public health prepared her for water crisis

Mona Hanna-Attisha, MD, the pediatrician who first discovered the lead-laced water in Flint, Mich., is having a surreal year.

"I come home every day and my husband asks 'What happened today' and I'm like 'I just met with the head of the HHS and the head of the CDC and I just did a press conference with our U.S. Senator and we introduced new legislation, and next week, I'm going to D.C. to testify in front of Congress," she told MedPage Today. "It's just surreal -- if I show you my schedule, it's unbelievable."

Hanna-Attisha is the director of the pediatric residency program at Hurley Medical Center in Flint, as well as an assistant professor of pediatrics and human development at Michigan State University's College of Human Medicine.

The medical school focuses on primary care, with an emphasis on community development. Because of the significant disparities in Flint, its Division of Public Health was moved there. An alumnus of the College of Human Medicine herself, Hanna-Attisha describes it as a "natural fit" for her because of her desire to merge the disciplines of pediatrics and public health in her career.

"Everything we do as pediatricians is pretty much public health anyways -- we give immunizations, we talk about prevention, eat your veggies and wear a helmet and sleep on your back," she said. "I love the one-on-one contact I have with patients, and as a profession in pediatrics, we understand the need to advocate at a broader level for our patients to ensure their safety and optimal health."

The first physician in her family, Hanna-Attisha is a first generation Iraqi-American immigrant who has lived in Michigan since her family emigrated to the U.S. when she was 5 years old. She majored in environmental health at the University of Michigan in Ann Arbor, where she did research on environmental justice. She then went to medical school at Michigan State.

Wanda Lipscomb, PhD, associate dean for student affairs at the College of Human Medicine said that Hanna-Attisha has always had a passion for social justice. She remembers Hanna-Attisha on her very first day of medical school, when she expressed concern about how few medical students were registered to vote.

"Mona came to my office and introduced herself and said, 'We need to do a voter registration drive, because I was talking to some of my incoming classmates and they're not registered to vote. I don't care how they vote, I just want them to participate,'" said Lipscomb. "She recognized that, as future practicing physicians, it was really important for medical students be engaged in the community."

After spending several years at the Children's Hospital of Michigan in Detroit, Hanna-Attisha returned to Flint to direct the pediatric residency program at the College of Human Medicine. In addition to her roles in pediatrics and public health, Hanna-Attisha also has a strong interest in medical education.

"I could never be not involved in medical education because when you have the learners -- the students and the residents -- your impact is so much more multiplicative," she said. "Throughout this whole story, I've had medical students and residents with me, because it's important for us to train the next generation of advocates as well."

Hanna-Attisha said that the whole water poisoning issue fell into her lap -- that was she simply the right person in the right place at the right time in terms of both her prior training and access to the data.

The city of Flint had switched its water supply from Lake Huron to the Flint River, and Hanna-Attisha learned from a friend that the city was not doing corrosion control on its water pipes, which prevent lead from contaminating the water. As reported on CNN, she then pulled screening data for children's lead levels prior to and after the switch in water supply, and found the prevalence of high levels classified as lead poisoning had doubled or tripled in many neighborhoods.

She held a press conference with other colleagues in the medical community in order to raise awareness of these findings, and after initial denials from the state, they admitted her figures were correct.

"People say 'Oh, you're a hero, you did amazing work,' and my response is this is my job -- this is the job of a pediatrician. It is our job to be the voice of the voiceless," she said. "Obviously I've never done anything to this capacity, but I feel like I was trained to do this, and this is what I train my trainees to do."

Lipscomb says when she found out it was Hanna-Attisha who discovered the problem with the water, she was not at all surprised. She also speaks of Hanna-Attisha's creativity, such as the creation of a pediatric clinic on the second floor of a farmer's market in downtown Flint. This ensures children can not only have access to fresh fruits and vegetables, but adequate medical care in one place.

"That's Mona. She's a problem solver," Lipscomb said. "She lives the mission of the College of Human Medicine. She's not that way in February 2016 because of hoopla -- she's been that way since she came to the college."

In addition to her regular jobs, Hanna-Attisha heads up the recently launched Pediatric Public Health Initiative, a joint project between Michigan State University and Hurley Children's Hospital. The goal is to build a model public health program to help the children whose growth and development may have been impacted by exposure to lead.

Hanna-Attisha says this will be done through research and assessment of exposure, long-term neurodevelopmental follow-up, and finally, advocating for evidence-based interventions such as early literacy programs, universal preschool and mental health services, to attempt to optimize the health of these children.

"All the federal resources that have come in have been for infrastructure and water, and we have yet to see any investment in children and health," she said. "So, we are still currently advocating for the necessary resources and interventions that the kids will need, so that we don't see the long-term consequences of this."

If doctors are faced with a similar public health crisis, Hanna-Attisha said she would advise her colleagues to use their power and credibility to do good for their community.

"We get so consumed with our daily work -- EMR and coding and reimbursement -- that we forget why we went into medicine," she said. "We forget that we can have such a large and powerful voice in our communities, so I would encourage, as I encourage my trainees, to use that voice. People will listen to you."

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